ACT in simple terms: it is a type of therapy that aims to help patients accept what

is out of their control, and commit instead to actions that enrichen their lives
(Harris, 2013).
Core Processes

Six core processes of ACT guide patients through therapy and provide a
framework for developing psychological flexibility (Harris, 2011). These six core
processes of ACT include the following:

 Acceptance;
 Cognitive Defusion;
 Being Present;
 Self as Context;
 Values;
 Committed Action.

. Triggers, Behaviors, and Payoffs (stop the function worksheet)

This worksheet is a fillable matrix on page 6 with one column for writing down
triggers (situations, thoughts, or feeling that immediately precede a certain
behavior), behaviors (what you actually do), and payoffs (the immediate outcomes
of the behavior that encourage the behavior to continue).

This worksheet can help you or your clients identify self-defeating behaviors with
the motivation behind them, which can be a first step to recognizing and modifying
problematic behavior.

. Bull’s Eye: Clarifying Your Values (page 9)

Another worksheet presents the Values Bull’s Eye, or a set of concentric circles
that are separated into four quadrants: work/education, leisure, personal
growth/health, and relationships.

The exercise involves placing an “X” on the circle that most closely represents
how you feel in the present moment.

The closer to the middle the X is, the more you feel you are behaving like the
person you want to be. The further out the X is, the less you feel like the person
you want to be.
The Cost of Avoidance Worksheet (pages 4-5)

This worksheet present four sentences for you to complete:

1. The thoughts I’d most like to get rid of are:

2. The feelings I’d most like to get rid of are:
3. The sensations I’d most like to get rid of are:
4. The memories I’d most like to get rid of are:

Avoidance Exercise activity

you write a list of everything you have done to try to avoid or get rid of these
thoughts, feelings, sensations, and memories. Distracting yourself from these,
avoiding activities, or using substances to self-medicate are a few examples of
avoidance techniques.

Then you are asked to consider these questions for each item:

1. Did this action get rid of your painful thoughts and feelings in the long
term?
2. Did it bring you closer to a rich, full, and meaningful life?
3. If the answer to question 2 is “no,” then what did this action cost you in
terms of time, energy, money, health, relationships, and vitality?

"Writing" Acceptance exercise

Submitted by Matthieu Villatte
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This exercise is a fun way to help clients understand acceptance.

1st part: The clinician gives a sheet of paper and a pen to the client and says "I'm
going to ask you to write a sentence if you're okay". Then the clinician puts an
obstacle (a piece of carton board, for ex) in front of client's eyes and says "Wait a
minute, is this annoying you if I put this in front of your eyes? Would you prefer if I'd
take it off? Well I'm sorry but I'm going to let it there though. However, as you said
you prefer to see while you're writing, I allow you to do everything you want to try to
see what you're writing. You can move your head, you can get up... Just do
everything you can to see what you're writing. Is that okay? So let's go!"

Usually, after 20 to 30 seconds the client has still not written anything readable
because s/he has been too occupied with trying to avoid the obstacle so we stop the
first part of the exercise. The clinician then says "How was it? Was it difficult? Have
you been able to write the sentence? Can we read it?" Obviously not.

2nd part: The clinician says "Well, I'm going to propose you another approach to help
you write this sentence finally. I'm sorry but I'm going to let the carton in front of your
eyes again. But this time, I propose you not to try to bypass the obstacle but to
concentrate your efforts on writing. Maybe it won't be easy but just do your best to
write the best you can so as we will be able to read the sentence."

Generally, the client very quickly writes a sentence that we are able to read and we
can debrief then. A possibility is to ask the client to write some action linked to
his/her value and to write on the carton the thing s/he tries to avoid (a painful thought
for ex). Also: sometimes clients or participants in workshops get the thing during the
first part of the exercise (i.e. s/he stops trying to avoid the obstacle and starts writing
the sentence).

This is good too because it means they understand the approach by themselves. But
it can be also interesting to encourage them to do as much as possible to see while
writing so as to make them observe the difference between the two approaches.

Here’s an exercise I often do with clients around this struggle…

Step 1: Find some activity or relationship in your life that you value, but from which you find
yourself pulling away. Maybe it’s a relationship you care about deeply but in which you’ve
noticed you’ve been less engaged. Maybe it’s an activity you care about but you aren’t taking
much action on.
Step 2: Now take out an index card or piece of paper. On one side, write down what you
value in that relationship or area of living. Who do you really want to be to that individual?
What are some descriptors of how you would like to be in that area of your life?  Now turn
the card over. On the other side, write down what difficult thoughts and feelings might show
up for you when you start taking action toward that value. For example, for my card with
Dalai it might look something like
Back of card
Pain:
Front of card  The thought “I’m not going to be
able to handle it when she dies”
Value:  The thought “This is too painful”
Being a caring steward and loyal companion  The feeling of anxiety of not
to Dalai for as long as she lives with us. knowing when her death will
happen
 The feeling of sadness and doubt
when I see her in pain at times
Step 3:  Now take that card and put it in your pocket, wallet, or purse. For the next week,
take it out and ask yourself: “Am I willing to have that card, both sides of it, in its totality or
would I choose to walk away from it?” Because, it’s a package deal, you can’t have one side
without the other.
Values are freely chosen; we get to decide whether we will pick up the card. What we don’t
get to choose is what’s on the other side of the card. Those things just come along for the
ride.
Mindfulness metaphors
The Mind Bully Metaphor

This metaphor is meant for people struggling with a particular emotion or

diagnosis, like anger, anxiety, or depression.

In this metaphor, the mind bully is our particular problem: it is an extremely large
and strong bully. We are on opposite sides of a pit, tugging back and forth on a
rope as the Mind Bully tries to make us fall into the pit.

When we pull on the rope, when we listen and pay attention to or even believe the
monster, we are actually feeding it. Like any bully, the Mind Bully can only harm
us when we engage with it and believe the negative things it says. In other words,
don’t let your mind bully your body.

Instead of pulling on the rope, what do you think would happen if we drop it? The
Mind Bully might still be there, hurling its insults and meanness, but it would no
longer be able to pull us towards the pit.

The less that we feed the Mind Bully, the smaller and quieter it will get. Maybe
eventually, we even will grow empathy for this sad creature and wonder why it
says such mean thoughts.

We stop feeding the Mind Bully by noticing and acknowledging it but shifting our
attention away from it instead of believing what it says. Engaging in a quick
mindfulness exercise can be a great way to do this.

The Sailing Boat Metaphor

This metaphor uses the setting of a small sailing boat, with “you” as the sailor.
Occasionally, waves send water over the side and into the boat, causing you the
inconvenience of wet feet. The boat includes a bailer to bail out this water, and you
know how to use it.

You are sailing a boat in the ocean with the bailer

So one day, when a particularly big wave breaks over the side and leaves water in
your boat, you start bailing.

You may start bailing calmly or mindfully, but eventually, you might find yourself
bailing desperately or wildly to get rid of all this water.

While you’ve been bailing, have you noticed what is happening to your boat?
Where is it headed? Where has it drifted to? Would it be fair to say you’ve been
bailing more than sailing?

Now imagine that you take a look at the bailer and see that it is really a sieve, full
of holes? What would you do?

The implicit purpose of bailing water here is probably to get your boat back on
track—once you rid the boat of the water. But if your tool is not suited to the task,
you will find yourself struggling to get rid of any water, let alone guide your boat.

The question is would rather be on a boat that has only a little water in the bottom,
but is drifting without direction, or on a boat that may have quite a bit of water in
the bottom but is heading in the direction you wish to go?

Writing Acceptance Exercise by Matthieu Villatte

This is a quick exercise for mental health professionals to help their clients
understand how avoidance can be counterproductive. This exercise can be
completed in the following steps:

 Give your client a sheet of paper and a pen and ask them if they are ready
for written instructions.
 Before the client can write anything, present an obstacle that obstructs the
client’s ability to see the paper and pen (e.g., a piece of cardboard, a mask
with severely limited vision, etc)
  Ask the client if this bothers them and if they’d rather be able to see as they
write. Inform them that the obstacle will stay, but they should still attempt to
work around the obstacle in order to write the sentence
 Let them struggle with seeing around the obstacle for 20 to 30 seconds.
They probably will not have written anything readable at this point
 Ask the client about their experience (i.e., “How was it? Was it difficult?
Were you able to write the sentence? Can we read it?”)
 Propose that the client stop trying to see around the obstacle, but just accept
that it is there and write the sentence anyway.

 The sentence they write when focusing on writing (instead of avoiding) will
likely be more readable. Point this out to them and help them make the
connection between avoiding the physical obstacle and avoiding emotional
pain, and the negative consequences of each.

Two Sides of the Same Coin by Jenna LeJeune

This exercise can be guided by a therapist or completed on your own. Following

these steps can help you or your client understand that suffering is an inevitable
part of life; if we eradicated suffering, we would also eliminate joy.

Follow these steps to give this exercise a try:

 Find an activity or relationship that you find valuable, but that you have
retreated from recently;
 Take out an index card or piece of paper. On one side, write down what you
value about that activity or relationship or what you hope to achieve or
become through it;
 On the other side, write down the difficult thoughts and feelings that
sometimes happen for you, when you take action towards gaining the value
or achievements written on the other side;
 Put the card in your pocket, wallet, or purse. Over the next week, take it out,
look at both sides, and ask yourself if you are willing to have that card, with
both the good and bad. You can either avoid both the value and the pain, or
you can embrace them both.